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**FOR INTERNAL USE BY LEADINGAGE NATIONAL & STATE ASSOCIATIONS ONLY**
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Search by CategoryAdult DayAssisted LivingBusiness Partners/Vendors
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Child Care for EmployeesCommunication with Resident FamiliesCommunication with Staff/Public/Members
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Communal Dining in AL/NHCOVID 19 Cases by StateFMLA
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Visitation to LTC FacilitiesWaiversWorkforce
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Date Msg SentStateStaffQuestionAnswer
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ADULT DAY
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3/13/2020GAGinny H.What are the adult day centers doing in your states? One of our largest ones in the state is closing temporarily. A director at the Georgia Department of Community Health said while they are currently allowing adult day centers to decide whether or not to stay open, she thinks they should be closing.
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3/13/2020MAElissa S.Executive Office of Health and Human Services are not requiring or even suggesting that programs close but realize that it may be in the interest of public health in certain circumstances. They are leaving that to the local boards of health. Attached is the guidance that the state has posted for day providers.
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3/13/2020WADeb M.Several, operating the majority of programs in the Seattle, Snohomish and Pierce County areas, have temporarily closed. They were asked to work with AAAs to identify those with a health care risk/need to ensure continuity of services. In those cases, adult day has mobilized their services and go the persons home. Our state is seeking waivers and funding.
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3/13/2020Gulf StateKaren C.AD is also under the order from the department that non essential visitor are prohibited. Non Essential visitor prohibition is for Hospitals, NH, AL, AD, PACE, HCBS.
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3/13/2020CAJeanne M.The information in CA has been sparse on ADHC. CDPH and DSS have put out some guidance, but the real emphasis has been on the facility settings: https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/COVID-19/guidance-for-individuals-with-access-and-functional-needs-03122020.pdf

We do know that several members who have social day programs have stopped admissions, and several PACE providers have closed or slowed to new admissions.
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3/13/2020IAShannon S.We (Iowa) also just had a call with our Adult Day members.None of them have closed yet but they are all screening visitors, participants and staff.

They wanted some support regarding what criteria they should consider for closing centers, examples/Sample communication templates for what that messaging looks like, and then any possible strategies on how they can continue to support the caregivers of their participants at home if hey need to close.
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3/13/2020VAMelissa A.We just had a call with our adult day centers and department of social services. It seems they will start closing as of next week. They have total discretion on what to do and just need to let the department know.
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3/13/2020ORRuth G.In Oregon, the state sent out an executive letter requiring the to suspend operations March 16-April 30.
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3/13/2020CTMag M.The state sent out an executive letter requiring AD to suspend operations March 16-April 30.
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3/13/2020RIJames N.Adult day guidance has been a bit of a void in terms of guidance. Ours are conflicted since the participants rely on the care they receive.
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3/13/2020ILJason S. The Illinois Department on Aging has ordered ADS providers to suspend operations for 30 days. 
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3/13/2020NCTom A.We’re trying to provide some guidance around adult day…does anybody have resources SPECIFIC to adult day?
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3/13/2020WADeb M.Our adult day programs closed, initially just in the hot spot areas, now I believe all have closed. They were asked to coordinate client needs, identifying those with necessary health care treatment needs, with the AAA. In some cases, they mobilized care delivery and our SA was seeking waivers to authorize and fund it. Not sure they are continuing to provide services based on availability of PPE.
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3/13/2020RIJames N.Our adult day programs closed, initially just in the hot spot areas, now I believe all have closed. They were asked to coordinate client needs, identifying those with necessary health care treatment needs, with the AAA. In some cases, they mobilized care delivery and our SA was seeking waivers to authorize and fund it. Not sure they are continuing to provide services based on availability of PPE.
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3/13/2020VAMelissa A.We’ve had 3 close so far and DSS is really slow on the uptake on this. Said we would have guidance in 1-2 weeks to which we might have laughed. Our pressure has resulted in more questions than guidance. Their initial response: “your folks have places to go so we aren’t worried about them”.
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3/13/2020COLaura L.Attached is guidance released from the Colorado Department of Health Care Policy and Financing (our state Medicaid agency) for Adult Day.
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Assisted Living
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3/19/2020TNGwynn E.Would there be a possibility of nurses from ALF's to provide med reminders and assistance to those Residents in Independent Living?
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3/19/2020NationalDee P.Gwyn, to your members’ question, I would encourage them to move extremely slowly on having AL nurses help with meds in IL. They definitely need to check with their state DSS/ DHS/ licensing boards on that question. I know that, in some states, it is not allowed and the AL nurse may put her/his own license on the line if she/ he administers care or medications outside of the licensed environment. This is where, instead, a physician’s referral to home health would be more appropriate, if the IL resident is dependent on a nurse to administer meds at home. Assuming the HH worker is permitted on campus… another alternative is an automatic med dispenser, which might, might be a more permissible solution, if the AL nurse is permitted by the state to fill the device…The only other thought I have at the moment on this topic: The community may consider temporarily admitting the IL resident to the AL. Some communities do offer “respite stays” on AL.
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6/4/2020VAMelissa A.Does anyone have any assisted living reopening guidance?
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6/4/2020KYTim V.Here are the Guidance for Beautician services in LTC for KY
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6/4/2020ORRuth G. Oregon in is Phase 1 of our reopening. Phase 2 will involve allowing visitors, guidance on that is being worked on now. Phase one guidance for opening of salons and residents leaving/re-entering the facility are attached. The guidance being issued are the same for nursing and assisted living.
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6/4/2020MAElissa S.Earlier this week Massachusetts announced that LTC and AL can allow visitation in outdoor designated areas under certain conditions -- outlined in the following memos. https://www.leadingagema.org/assets/COVID19/LTCF-Memo%20Visitation%20Guidance_5%2031_20%20vF%20clean.pdf
https://www.leadingagema.org/assets/COVID19/ALR%20Visitation%20Guidance%2005%202920%20-%20June%201st%202020.pdf
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6/4/2020OHKathryn B.When the Governor announced the reopening of Assisted Living, he actually highlighted the work done collaboratively by LeadingAge Ohio, the Ohio Health Care Association, the Ohio Medical Director’s Association, the Ohio Assisted Living Association and the Academy for Senior Health Sciences (see “Visitation Considerations” attached). !! We have a VERY thoughtful Director of Aging in Ohio; she met with the associations for several hours with her team, as well as the Ohio Department of Health, to walk through the paper we provided in order to craft the state’s published guidelines (attached). The visitation is for outside visitation only; visitation for AL only. Attached a pdf a small group of Ohio members crafted to assist staff think through the risks they take in their travel and gathering decision-making now that the world is re-opening.
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6/4/2020MNGayle K.We are still working on guidance with state
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6/4/2020MOBill B.Missouri’s Dept. of Health & Senior Services has been working on our “reopening” plan for SNFs and ALFs – it may be out later today. We’ve been consulted on it and believe it will largely adhere to CMS guidance for SNFs and AlFs. However, like Ohio, our State considers it Guidance, not a mandate. But, Missouri seldom reinvents the wheel. Testing will be the sensitive issue – who pays?
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6/4/2020WADeb M.My understanding is that Medicare covers for residents and you need a physician’s order to bill. Not too problematic for SNF residents. For AL residents it’s a different matter, many residents don’t have a primary care doc and the AL facility doesn’t have a medical director.

Staff are yet a different problem. Not all staff have insurance - some are underinsured. Staff don’t want to be saddled with the copay or deductible cost. Also, under their insurance they are limited to one test. Staff who are asymptomatic don’t want to use their one test benefit. Our state has therefore said that all staff testing will be paid for by the state using CARES funding, presumably. Again we have the issue of a physician’s order - no primary care doc for many of our staff even those who may Health insurance. Our local public health jurisdictions in two counties have written medical orders for staff working in King and Snohomish counties. They won’t do it again if we move forward with cadence testing. Whether other county MDs will write orders is unknown.

All SNF baseline, point prevalence testing must be completed by June 12th. We won’t make it and have asked for an extension. Labs aren’t prepared and can’t process the volume. One lab had a broken machine which was discovered god knows how many days after tests were analyzed. False test results were given out to god knows how many staff/residents. PPE that they’re receiving is a joke, it’s absolutely reprehensible that what FEMA has provided counts as PPE. The gowns, which look like blue plastic tarps, cannot be donned and doffed (never before covid have I ever used those words before!) without risking infection spread. The masks are paper ear loops.

Confusing and conflicting information abounds from our department of health, licensing agency, Medicaid agency and local health jurisdictions.

Our testing “plan” was rolled out without our input (Except to ask questions about whether a number of issues had been considered and whether we could expect to see guidance) and with scores of questions unanswered and remain unanswered nearly one week after roll out. Questions about who the facility is responsible to test - direct employees, contracted staff such as home care and hospice, student nurses, etc. What if staff refuse to test, what is the state’s expectation? What if residents refuse to test? Do we quarantine those that refuse for a period of time? Is there a plan for back-up staff when we find asymptomatic positives? Are we ready for the asymptomatic residents and where will they go if our isolation units are at capacity? One outbreak will exhaust current PPE supplies for many facilities, then what?

AL and adult family homes must complete testing two weeks following SNF completion. That deadline will not be met. Single largest issue is physician orders.

No decision has yet been made on cadence/repeat testing. God help us.

We need testing but we need all partners in the test cycle to be informed with consistent instructions, they each need to be prepared and have the supplies and capacity to perform as expected. The state has to pay for testing. If left to staff to have to cover through insurance, they’ll likely refuse and many are uncovered. Facilities can’t afford it. Yet another reason to leave the aging services field.
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6/4/2020IASharon S.Iowa’s LTC Reopening Plan.

They are only requiring baseline testing of staff. Resident baseline testing required to some degree if a provider has had a case.

After the initial baseline, testing will be done for symptomatic and exposed situations. The state will also engage in sentinel testing based on factors like virus activity in a community and IC survey findings, among others.

State intends to pay if cannot be billed elsewhere like Medicare for residents…
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6/5/2020INEric Please see the two documents from Indiana. One (Outdoor Family Visitation at Long-term Care Facilities (updated 6/03/20)) went into effect Tuesday and the other one (attached) will come out today and go into effect next Friday (much more helpful).

As or testing – In Indiana all staff should (strong should – but not a penalty-based mandate) be tested (even if previously tested) in the month of June. The state is paying for all of these tests (after much prodding from us and IHCA). Staff (and this includes everyone at the SNF (temps, contract staff, volunteers, admin, Exec. Dir., etc.) can either go to a free site or the facility can request test kits be sent to the facility where they’ll be administered by other staff. This testing plan does not include ALs or other non-SNF facilities. It also does not suggest that there ever will be required a follow up test, or repeat testing, etc. (one-time deal for now). It does not apply to residents, and while there has been some talk of this – I highly doubt it ever goes past this one time staff testing event.
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Business Partners/Vendors
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4/6/2020TNGwynn E.I’m sure I’m not the only one getting emails from our business partners being helpful and asking us to put their info in our emails/newsletters to our members. No doubt they are helpful, but I’m also trying to streamline to CDC/CMS/LA and not muddy the waters for the members. We know their inboxes are as atrocious as our own right now. How are you handling these request and how do you determine what to include, if anything? I’m thinking some answers may be ‘depending on their sponsorship/membership level’ and I’m not sure about that right now…
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4/6/2020PAAdam M.We set up a dedicated page for their resources so that they can feel heard but not create additional inbox volume: https://www.leadingagepa.org/Membership-Networking/Benefits/COVID-19-Business-Member-Resources
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4/6/2020RIJames N.That’s a good idea.
I have just been thanking them, feigning interest, then deleting.
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4/6/2020MAElissa S.We proactively reached out to our business affiliates asking if they have information/programs/resources to support our members relative to COVID-19 to share those with us and we would post relevant information on our website. We have a dedicated spot on our COVID-19 resource page for Information and Resources from our Business Affiliates. We worded our request in a way that does not guarantee we will post everything as we may determine the resource is not really specific to COVID-19 support.
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4/6/2020NationalSusan D.Nationally, we are also posting business offers for members. Burt’s team leads the process of reviewing and curating offers (as well as our formal partner relationships), so I’ll let him weigh in on that piece – but you can find our list of offers here.
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4/6/2020CAJeanne M.We are setting up something similar to facilitate the sharing of PPE Contingency Strategies.

https://www.leadingageca.org/covid19-resources
AoRo-e-sig-NEW
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4/7/2020MDAllison C.We are similarly gathering resources, links, articles, etc from business members and sponsors, and we include these on our COVID-19 resource web page. Trying to find creative ways to keep highlighting our sponsors during this time.
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Child Care for Employees
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3/16/2020PAAdam M.Have any of your states provided allowances for “pop-up” day cares or other flexibility to help staff with kids get to work? We have several members interested in finding or creating alternative child care strategies now that all schools are closed state wide, and with most day cares beginning to follow suit.
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3/16/2020NationalNicole F.In MN, our governor has closed the schools to kids, except those whose parents are first responders and health care workers, and were instructed to also assist with after hours care for these same kids (not sure how it is going to work yet). Our YMCAs are also closing but will continue to serve children of those same workers. This, obviously, does not help for other workers.
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3/16/2020CTMag M.We are currently working with the state to set up the guidelines for “extraordinary expense” reimbursement – something our state has in statute to address these situations and which is usually used in strike situations.

We have asked them to consider child care costs that are reimbursed for employees as extraordinary expenses. Our office of Early Childhood Education is trying to assist in getting information out to the health care employees and matching up slots – but it is only a matter of time before these child day care centers are closed too.

Our child care licensing requirements have been waived so hospitals can set up sites – but that is not really doable in a SNF with the visitor ban. So we asked if one on one child care/babysitting can be reimbursable.
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3/16/2020WADeb M.We have communities trying to set up daycare with the local church for their employees kids. One Adult Day member opened one in part of their adult day area, since adult day attendance is way down. They closed one door in the area and have AD coming in an outside door. The rest of the space is being used by employee kids. Daycare is run by adult day staff, one is in with the AD clients.
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3/16/2020TNGwyn E.Locally, I’m seeing several churches opening and offering free child care to hlth care folks and ER responders. Private sector trying to help but also trying to do what is being required and requested by CDC so I’m getting questions from them.
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3/16/2020ILJason S. The Governor has ordered child care centers to close as of March 20.  An emergency child care license is available for essential workers.
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Legislative Actions on Child Care
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3/19/2020NationalKatieOhio, Gov. DeWine issued a temporary exception/order issuing “pandemic childcare licenses” to providers ONLY for children of healthcare and essential service workers.
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3/19/2020MAElissa S.The Governor ordered all child day care to be shut down in the state effective Monday. His order allows an exemption for emergency child care that will be approved by the state for the children of workers who must be at work including health care workers. We have been told that children of long term care employees will be included. The state will be paying the costs for families. I have no idea how many will be available ( a list is supposed to be posted this weekend). Here is more information on the order:
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3/25/2020NationalNicoleTemporary Pandemic Child Care Begins Thursday 3/26
Governor DeWine reminded Ohioans that beginning Thursday, March 26, all operating child care centers in Ohio must do so under a Temporary Pandemic Child Care license. The Governor announced the closure of all child care in Ohio except for those operating Temporary Pandemic Child Care licenses.

Placement of children must first be offered to kids with parents who are healthcare workers, first responders, hospital and clinic staff, pharmacy staff, children service workers, adult protection workers, developmental disability aides, mental health counselors, psychiatrists psychologists, nursing home workers, elder care workers, home health care workers, and dentists.

Children in the pandemic childcare centers will be limited to 6 per classroom, and efforts will be made to group children from a single employer, further reducing the risk of community spread of the novel coronavirus.
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3/18/2020KSDebra Z.Anything guidance to clear the path for “pop-up” child care programs, for general population of specifically for children of health care workers? Starting to get members feeling the pinch, esp now that all public schools are closed for the rest of this school year in KS.
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3/18/2020NCCommunication with Resident Families
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3/18/2020OKMary B.Some of my members wanted to do a “pop-up” day care…but DHS won’t let them at this point. I am working with them to identify child care centers with capacity. The child care centers reached out to DHS… since schools are closed all kids are home and the child care center census has dropped dramatically so they said we need to support them before allowing any other options.
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3/18/2020CTMag M.Spoke with our Office of Early Childhood Ed yesterday – she was appointed by the Governor to do this. Thought there would be an influx of child care need from Hospitals, but discovered hospital workers do not want their children in group settings. They have a dedicated line for health care workers to help them figure out child care and they have sort of a triaging approach. (attached)
They will help accelerate a pop up license – but nursing home are closed to visitors – so the location would be challenging.
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3/18/2020NationalDee P.A couple members talked about this during our LPC Futures group; one suggestion, to circumnavigate the licensing issue, was to reach out to existing, external child care centers or churches, and ask/ pay them to stay open just for children of healthcare providers. WC Chesapeake Bay (VA) and The Osborn (NY) are both exploring this option. Others on the call responded favorably to the idea. Notes on this and other topical discussions related to COVID, attached.
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3/18/2020WADeb M.Has this come up anywhere and, if so, do you have a copy of a letter from the community to family members?

Situation: member set up communication via Skype between residents and family members. Family members are showing up at the facility and knocking on resident windows and saying hi. This is highly disruptive and unsettling to some residents, particularly those with dementia.

We need the facility to send a letter to families (looking for samples) and maybe even a press release?
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3/18/2020NCTom A.Here’s some information one of our communities shared with residents regarding this very issue…
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Communication with Staff/ Public/Members
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Tools for Staff Conversations
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3/18/2020NCTom A.Practices tools for Staff Conversation
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3/18/2020NationalMollie G.Given the topic that Tom brought up, I wanted to share a resource from VitalTalk which is a great nonprofit that focuses on serious illness communication skills for clinicians. They posted a COVID-19 communication tool that I think might be useful for members.

https://www.vitaltalk.org/guides/covid-19-communication-skills/
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3/19/2020IAShannon S.Do you know, how providers are communicating if an employee is diagnosed with COVID19?
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3/19/2020WADeb M.COVID 19 LPC Member Notice Positive Employee Resident (click on the link to see the notice)
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3/19/2020CTMag M.Media Statement when resident is diagnosed
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3/20/2020NYJim C.Attached are 2 media releases dated 8 days apart from one of my CCRC members. The first is from when the first staff person tested positive. A very unfortunate real world example of what is happening on the ground. And this campus did everything by the book before and after getting the notice of a positive case.
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3/19/2020TXGeorge L.Anyone have any polices that they could share in regards to having a patient that test positive? What procedure did they follow with staff? As well as care for the individual?
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3/19/2020CAJeanneThis is the guidance we have on our website:

https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and/guidance-infection-control-and-prevention-concerning-coronavirus-disease-covid-19-faqs-and
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3/19/2020CAJeanneHere's guidance more specific to LTC setting
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3/20/2020NYJim C.Attached are 2 media releases dated 8 days apart from one of my CCRC members. The first is from when the first staff person tested positive. A very unfortunate real world example of what is happening on the ground. And this campus did everything by the book before and after getting the notice of a positive case.
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3/30/2020CTMag M.Debra posted a great message to CNAs and Aging Services on her facebook page. Has anyone developed a LeadingAge message to thank all of our members and their employees for what they are doing – something we can steal to post on our facebook, etc.? Maybe even publish as an ad in local press? Asking before I try to create one ourselves.
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3/30/2020PAAdam M.In PA we created a campaign: https://www.leadingagepa.org/About-Us/Share-Your-Heart and launched it with a little video:

https://animoto.com/play/QPiPj84N2PmczvoGyzp25A?fbclid=IwAR2CsNL9LP46rUNZv2gV31uSJA707BLNy4uRe0GGfOEIiyrorsaq_z2Dgh8

Feel free to use!
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4/1/2020VAMelissa A.Are you reporting cases to your members as you learn to them? Because so many communities share staff, my members are asking me to notify them. How are you handling this?
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4/1/2020Gulf StatesKaren C.I provide my members in my morning update with the link to the website where they can get the numbers and communities where there are outbreaks.
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4/1/2020WADeb M.We encouraged our members to find out from their employees if they take shifts in other communities including dietary, nursing staff, housekeeping, etc,. Once they know other communities in which staff work, we then invited them to contact us to find out if that community is on our list of suspected and known COVID buildings. We’ve received a number of calls and members appreciate confirming this information so they can take heightened precautions to prevent spread. They’ve also appreciated not publicly distributing the list given the media attention. We get an updated list every week.
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4/1/2020OkMary B.Our state agency has not made a list available…I asked and they declined…
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4/1/2020CTMag M.I am not. I am sharing one on one as members become positive if they want to talk with someone about what/how to do things. Some members are open about it on the calls.

Regarding staff – we have advised members to get in touch with the other buildings that the staff has indicated on their questionnaire that they work at – and to work out something between themselves to notify each other. I think Jodi suggested this also on a call. This way – even if it is not a facility infection issue, but maybe a personal exposure issue, they can communicate it.
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4/1/2020TNGwyn E.Ditto, ours won’t. It has been one of my continual request but I would not make it public in my emails or newsletters but handle it as necessary or asked. Just my feel.
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4/1/2020Gulf StatesKaren C.As I reread this memo. We do not get the number of cases by community but the communities are listed on the website as having a cluster. Cluster defined as two or more.